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• Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />• Print your name and address on the reverse <br />so that we can return the card to you. <br />• Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />�� 1 � ► C� �oc�31 <br />A. Signature / °� !S ❑ Agent <br />X ejla7h ❑ Addre <br />B. Received by ( Printed Name) C. D j tel <br />M* <br />D. Is delivery address different from item 1? ❑ Yes <br />If YES; .ei t delivery address below: ❑ No <br />3. Service Type <br />❑ Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7012 3460 0000 $332 7615 <br />(Transfer from service labe. <br />PS Form 3811, February 2004 Domestic Return Receipt 102595 -02 -M -1540 <br />FEB 7 6 ?01,5 <br />` wlaa t Of Reclamation, <br />Mining & Safety <br />